<%@ Page Language="C#" %> Willingness to Serve

Willingness to Serve

Greater Los Angeles Area

Name:		APIC Number:
Phone Number:
Email:
Facility where you work:
How long have you been a member in the Greater LA APIC chapter
Have you served on the LA Chapter Board in the past?	Yes No	If so, what year?
Are you serving as a Board Member at another APIC chapter		Yes No

I am interested in serving on the Board for the chapter (check your interest)		President elect
		Secretary
		Treasurer
		Member-at-large
		(not interested this year; would like to in the future
I am interested in volunteering my time/talents and have this much time to offer:		10 minutes - one time monthly
		One Hour - one time monthly
		> one hour if needed
My primary interest in being part of this chapter is to:
Meet other people who do my job
Want to help others learn
I need to help others learn

Please attach your resume